Welcome To The Oregon Intervention System (O.I.S.) Workshop

1. Welcome ToTheOregon Intervention System (O.I.S.)Workshop 2019

2. Brief Introductions 2019

3. Workshop • Behave in a professional manner! • Demonstrate respect for others • Be considerate • Be on time for workshop and from breaks • Turn cell phones and other electronics off/silent • Respect confidentiality! • Participate in group discussions 3

4. This Workshop will include: O. I. S. Overview, Values, and Positive Behavior Support Module 1: Relationships and Communication Module 2: Understanding Behavior Through Trauma Module 3: Positive Behavioral Supports - Presets Module 4: Positive Behavioral Supports – Setting Events and Challenging Behavior 101 Module 5: Positive Behavioral Supports – Quality of Life Module 6: Mental Health Introduction Mental Health Disorders or Autism Spectrum Disorder Module Module 7: Stress and Emotional Control Module 8: Emergency Crisis Management

5. O.I.S. Overview O.I.S. is an evidenced based system to assist Designated Persons in understanding, preventing, and responding to challenging behavior, through Positive Behavior Support.

6. O.I.S. Values • Respecting rights, treating others with dignity, and acknowledging their citizenship. • Person Centered: Behavioral challenges are approached on an individual basis. Although similarities may occur, each behavioral challenge is unique to the person. • Behavioral challenges are complex and require a team-based collaborative decision-making process.

7. O.I.S. Values • Challenging behaviors are approached from the evidenced based framework of Positive Behavior Support. • The core principles of O.I.S. emphasize the importance of proactive and preventative strategies rather than “reactive” strategies.

8. O.I.S. ValuesProfessional Integrity

9. Class Exercise Develop a list of at least 5 staff strategies in each of the following categories:

10. POSITIVE BEHAVIORAL SUPPORTS(PBS) • As noted in the OIS Values, PBS recognizes challenging behaviors are complex and the supports are person centered. • A major goal of PBS is helping the individual to learn to enjoy their lives and living as independently as possible. • PBS recognizes that those individuals receiving these supports have rights as any other citizen. • PBS also recognizes that these supports are developed in ways that maintain the individuals dignity.

11. POSITIVE BEHAVIORAL SUPPORTS(PBS) • The challenge for designated persons performing PBS is not focusing on the problem, rather focusing on the outcome of the support. • Relationships, Communication, Trauma, past Behavioral approaches, and Quality of Life are all components in assessing and understanding challenging behavior from a PBS viewpoint. • OIS incorporates these assessments within this workshop.

12. Module 1: Relationships and communication

13. Relationships A sense of belonging is a basic human need (Pellentier, 1994). • People with satisfying relationships are: • Happier • Have fewer health problems • Live longer (Harvard Medical School, 2010)

14. Sad Truth • Many individuals we support have no friendships in the community. • Family relationships may be tentative, infrequent, or non-existent. • Although paid providers can be wonderful, these relationships are often conditional and fleeting.

15. What’s important • The relationship with paid providers is often rated by individuals with intellectual disabilities as highly important (Willems, 2016) • Parents of people with intellectual disabilities and people with intellectual disabilities want Designated Persons that are: • Positive and friendly • Listen sincerely, with sensitivity • Show real interest • Handle power/authority in an acceptable manner • Respectful, empathetic, and accepting • Able to build a trusting relationship Clarkson, Murphy, Coldwell, & Dawson, 2009; Dodevska& Vassos, 2013; Moonen, 2006; Roeleveld, Embregts, Hendriks, & Van den Bogaard, 2011; Van der Meer, Embregts, Hendriks, & Sohier, 2011

16. Building Relationships • Begin your relationship by getting to know the person, not jumping into the personal care part of your job immediately. • Relate to the individual through interests. • Be interested in the individuals interests even if you don’t share the same passion.

17. COMMUNICATION in RELATIONSHIPS https://www.ted.com/talks/celeste_headlee_10_ways_to_have_a_better_conversation?language=en&utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare

19. Communication in Relationships Exercise Write a one sentence definition of : Effective Communication Effective Communication: The means through which people exchange information, feelings, and ideas with each other. Often times this is difficult for those we support.

20. Communicating with Empathy https://www.youtube.com/watch?v=1Evwgu369Jw

21. Communication in Relationships By not feeling the same emotion of the other person… By truly not listening to the person’s communication… Our communication could go wrong

22. When Communication Goes Wrong http://www.youtube.com/watch?v=KtiJAexxSPo

23. What is a Power Struggle?

24. Avoiding Power Struggles • Do • Be Compassionate • Make it a teaching moment • Allow individuals to save face • Use I-statements • Focus on the individual’s feelings instead of the behavior • Don’t • React unless the behavior becomes dangerous • Let your emotions control your behavior • Attempt to get the last word • Use language that puts the person on the defense

25. Resolving Power Struggles • Power struggles tend to escalate as they cause both parties to become stressed. • It is not always easy to stop the escalation. • Recognizing that you are in a power struggle is the first step.

26. Resolving Power Struggles • Disengaging techniques • Use a brief, simple, stress-reducing technique prior to responding (e.g. deep breath) • Use a calm, neutral, matter of fact voice tone • Avoid reacting to every response • Keep the response brief

27. Resolving Power Struggles • Interrupting techniques (well timed, supportive responses that interrupt the escalation) • Divert attention from the conflict • Engage the person in a neutral task • Ask who, what, where, when and how questions (avoid why questions) • Offer a break • Paraphrase concerns

28. Resolving Power Struggles • De-escalating techniques • Turn a negative statement into a positive statement. • Use body language to defuse the situation • Help the person save face • Use humor • Label the emotion • Consider what the person is trying to convey with their behavior.

29. How we communicate is influenced by our beliefs and biases

30. EXERCISE

31. Our Beliefs Matter • Beliefs are the guiding principles in life that assist us in making decisions and give life meaning. • Beliefs originate from our experiences and environment. • Beliefs filter our perceptions of the world (external and internal).

32. Biases Bias is when we make decisions based upon a category attribute, our assumptions, and our beliefs. Game:

33. Supported by Research Smart rats vs. Dumb rats Gifted students vs. average students

34. Beliefs and Bias Cycle

35. Summary • Building and maintaining positive relationships with the people we support is the foundation of our field. • How we listen in our communication is an important part of relationships. • Our communication is influenced by our biases and beliefs.

36. MODULE 2 Understanding Behavior Through Trauma

37. Trauma Trauma is any experience or series of experiences that make the individual feel that he or she is in danger of dying, or of being emotionally “wiped out” or annihilated. (Palay, 2013) Trauma destroys the instinct of purpose (Van Der Kolk, 2018) Traumatized people are all feelings (Van Der Kolk, 2018)

38. Sobering StatisticsU.S. Department of Justice 2011 Report • Only 37.3% of individuals with disabilities who were the victims of abuse reported their abuse to the authorities. • In 52.5% of the cases that were reported, nothing occurred as a result of the reporting. • For individuals diagnosed with autism, 77% reported having been bullied; for individuals diagnosed with intellectual developmental disabilities 64.3% reported having been bullied. Age-Adjusted Rates of Violent Victimization per ,1000 People with DisabilitiesPeople Without Rape/Sexual Assault 2.7 0.9 Robbery 8.3 1.8 Aggravated Assault 10.6 3.3 Simple Assault 26.1 13.4 Males 42 22 Females 53 17 S. McGilvery, Ph.D., 2018

39. Types of Trauma for Individuals with I/DD • The disability itself • Emotional, Sexual, and Physical Abuse • Institutionalized living • Bullying, teasing, social rejection • Loss of relationships including family, staff, and peers • Changes in living environments • Loss of job

40. Big “T” Trauma Life events that cause severe disruption to the normal patterns of ones life may be considered big T trauma: • Sexual/Physical Assault • War • Natural or manmade disasters • Catastrophic illness • Traumatic loss of a love one • Prolonged deprivation and powerlessness to act on one’s own behalf

41. Little “t” Trauma • When one’s coping is limited and common stress-inducing experiences are repeated or become chronic, the frequency of those experiences may lead to little “t” trauma. • Feeling different • Not being accepted/social isolation • Feeling humiliated • Not being able to do what others do • Moving to a new home or significant change at home • Not being listened to • Being misunderstood • Failing at a task • Getting confused or overwhelmed (Ford, Adler-Tapia, 2009)

42. The Brain and Trauma • The brain does not differentiate between physical, emotional, or observatory trauma. All are interpreted by the brain as trauma. (Palay, 2013) • After an individual experiences a traumatic event their world is experienced with a different nervous system as their perception of risk and safety have been altered. (Van Der Kolk, 2014)

43. TRAUMA https://vimeo.com/100518405

44. Manages Incoming/Outgoing Messages Links Nervous & Endocrine Systems Smoke Detector Learning and Memory

45. The Amygdala • As we noted in the diagram, it is located under the hippocampus and on both sides of the brain. • Identifies threats • Exists in the present; relies on other parts of the brain to place threatsin context • Sets into motion (1/20 of a second) flight-or fight chemical norepinephrine, cortisol • Decides between need for aggression or fear

47. The Emotional Brain https://www.youtube.com/watch?v=2m7ktHq1Nn0

48. Trauma and Behavior • We recognize that Trauma affects an individuals ability to manage their emotions and affects their behavior and mental health. • Therefore, our Behavioral Interventions should acknowledge that the behaviors exhibited are symptomatic of Trauma and dysregulated emotions.

49. Trauma Behavioral Pyramid (Harvey, 2013) Trauma Behavior Emotion Dysregulation Physical Trauma Emotional Observatory

50. Remember • When the “Emotional Brain” is activated the “Rational Brain” is “off line” • Using words to calm someone who is “reactive’ is not attending to the Emotional Brain but to the Rational Brain.